Medicare Therapy Cap
Exceptions Process Set to Expire
Unless Congress takes action before December 31, 2011, some
Medicare beneficiaries will lose access to critical speech, physical and
occupational therapy services. Why is this coverage at risk?
In 1997, Congress sought to control Medicare spending.
One way they accomplished this was by limiting, or capping, the amount of money Medicare
spends per person, per year on speech, physical and occupational therapy
obtained outside the hospital. Congress set annual caps for these services—in
2012, those caps are $1,880 for physical and speech therapy (combined) and another
$1,880 for occupational therapy.
After these caps were enacted, Congress recognized that
some patients need more therapy services than the capped level of funding
provides. In 2006, they created an exceptions process, which allows patients
who reach the cap to receive additional therapy services if the services are
determined to be medically necessary. Congress has extended, or reauthorized, this
process every year since it was created. However, they have not acted to
reauthorize it this year. If Congress doesn’t act before December 31, the exceptions
process will expire. This means that Medicare will not pay for additional
rehabilitation services, even if those services are medically necessary for a
stroke survivor’s recovery.
The Stroke Advocacy Network has
supported legislation introduced by Senator Ben Cardin (D-MD) and Representative
Jim Gerlach (D-PA) to permanently repeal these therapy caps—S. 829 and H.R.
1546, collectively known as the Medicare Access to Rehabilitation Services Act.
Our advocates voiced our support for these bills during our 2011 Lobby Day on
Capitol Hill this past June. Despite collecting a combined 143 cosponsors
(i.e., members of Congress who have stated their support for a certain bill), these
bills have stalled in both the House and Senate.
Now is a crucial time to make your voice heard
on this issue. Tell Congress how important therapy services are to stroke
recovery and encourage them to make sure stroke survivors have access to enough
therapy to recover to their fullest potential. Ask Congress to reauthorize the exceptions
process beyond December 31, 2011. Let the Stroke Advocacy Network help you take
action on this issue today.
|NIH Funding Levels
National Institutes of Health (NIH) conduct vital medical research on many
conditions, including stroke, to help identify more effective treatments and
prevention strategies. Two months into fiscal year 2012 (FY 2012), the budget
for the NIH has yet to be finalized.
Since the beginning of the fiscal year on October 1, Congress
has passed a series of short-term funding bills that have kept the federal government,
including the NIH, operational while budget negotiations continue. These
short-term spending bills have funded the NIH at a level 1.5 percent below last
year (FY 2011), and the last of these bills is set to expire on December 16.
In order to finalize a budget for the NIH, Congress typically
passes what is called an appropriations bill. There are 12 individual
appropriations bills, and each one funds a particular group of federal agencies
and departments. This year, both the House and Senate have passed their own
versions of the bill that funds NIH in FY 2012, which also funds other programs
related to the departments of Labor, Health and Human Services and Education.
The Senate version proposes to cut NIH funding by $190 million, while the House
version proposes to increase it by $1 billion.
In a regular budget cycle, the House and Senate would
come together and work out the differences between their versions of this
appropriations bill. Once the House and Senate agree to the same version of the
bill, it goes to the President for veto or signature. (Read more about how a
bill becomes a law here.) However,
this year the House and Senate have been unable to agree on a single version of
the bill. At this time, it is unclear how Congress intends to resolve this
issue. A likely outcome will be that Congress combines all the remaining
appropriations bills, including the one that funds NIH, into what is typically
called an omnibus bill. Both the House and Senate would vote on this omnibus
bill (instead of voting on all 12 appropriations bills individually). No matter
how this issue gets resolved, Congress will be making decisions about NIH
funding in the next few weeks.
National Stroke Association strongly supports
the increased funding level for the NIH proposed in the House appropriations
bill. Tell Congress that you want them to vote to increase NIH funding next
year—to help find better treatments and prevention strategies for stroke. Visit
Advocacy Network website to find out how you can take
|World Stroke Day—You Made a Difference
In October, National Stroke Association asked members of the Stroke Advocacy Network to contact Congress about World Stroke Day. We asked that members of Congress speak out about stroke in honor of World Stroke Day, which was October 29.
Over 450 Stroke Advocacy Network members from 44 different states sent more than 1,500 messages to Capitol Hill. Representatives Lois Capps (D-CA), Virginia Foxx (R-NC) and Carolyn McCarthy (D-NY) answered your calls. Read their statements here: Lois
Capps (D-CA), Virginia
Foxx (R-NC) and Carolyn
McCarthy (D-NY). Additionally, Representative John Larson (D-CT)
posted about World Stroke Day on Facebook and Twitter. If any of these members
of Congress represent you, please contact them by email, phone, Facebook or
Twitter to thank them for their support of the stroke community. You can find
out who represents you and reach their official congressional Web pages on the Stroke
Advocacy Network website or
|What’s Happening in Your State?
Over the past year, the Stroke Advocacy Network has provided opportunities for you to make your voice heard in Washington, D.C. on stroke-related policy issues. In 2012, the Stroke Advocacy Network is expanding into a statehouse near you!
Our new state advocacy Web pages will allow you to follow stroke-related legislation being debated in your state. The pages will include information about your state’s legislature, who represents you at the state level, stroke-related legislation being considered and how you can watch and participate in your state’s legislative process.
Watch for future announcements about this new feature of the Stroke Advocacy Network’s website, and prepare to make your voice heard at home as well as on Capitol Hill.